Healthcare Provider Details

I. General information

NPI: 1003406125
Provider Name (Legal Business Name): WILLIAM JEFFREY LANGDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E PRICE AVE
SAVANNAH MO
64485-1742
US

IV. Provider business mailing address

4409 APPLETREE CT
SAINT JOSEPH MO
64506-3697
US

V. Phone/Fax

Practice location:
  • Phone: 816-324-5111
  • Fax:
Mailing address:
  • Phone: 816-387-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029584
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: